Towards a Learning Health Care System Experiences in Kootenay - - PowerPoint PPT Presentation
Towards a Learning Health Care System Experiences in Kootenay Boundary Jennifer Ellis, QI Manager, Kootenay Boundary Division of Family Practice March 6, 2020 Kootenay Boundary 78,000 people 93 GPs and 6 NPs in family practice 49 ED
Jennifer Ellis, QI Manager, Kootenay Boundary Division of Family Practice March 6, 2020
78,000 people 93 GPs and 6 NPs in family practice 49 ED physicians, hospitalists, locums, GPs/NPs in focused practice 50 specialists 26 primary care clinics 3 hospitals with inpatient beds 3 health care centres with EDs open in daytime only
“science, informatics, incentives, and culture are aligned for continuous improvement and innovation, with best practices seamlessly embedded in the delivery process and new knowledge captured as an integral by-product of the delivery experience.” Institute of Medicine, 2015
QI not QA
The data is a conversation starter. Establish a blame-free culture that allows falling forward.
Data literacy based
Talk about the data. Explain what
things mean and how they were
Voluntary but value-add
Bring people along by helping them to see the value of the work and information. Get feedback on approaches.
Data and tool democracy
Share data openly with safeguards. Build and share a library of tools to enable shared language and common approaches.
Sucient resourcing
Data collection, analysis and sharing takes time and money. This cannot be done off the side
Imperfection is expected
And accepted. The data is messy. The tools are imperfect. Some things seem unmeasurable. But there is a need to move forward.
Outcomes focus
Understand what you are trying to achieve and how you will know change is an improvement. Logic models!
Measure twice (or more)
Use a diverse set of measures to to triangulate, tell a robust story and account for the unexpected.
Ground in the literature
You're probably not the rst to try to do something. Learn what you can from the experiences of others.
Relationships enable
Trust is integral to data sharing, data collection and discussions about
Disaggregate data
The data must be as disaggregate as possible enabling people to see themselves within it while still preserving trust and privacy.
Decentralization and Self-management
A learning system cannot be top down. Ideas must ow up and down and local people must be empowered to self- manage.
Embedded evaluators and QI coordinators
Builds relationships and trust Keeps the focus on data, outcomes and learning Enables formative evaluation and regular feedback loops
Protected budgets for QI and evaluation
Creates buffer and allows for experimentation Ensures evaluation always happens Evaluation, QI and data sharing becomes an organizational norm
Evaluation and QI roles separate from project management
Project managers do not plan or execute evaluations and evaluators/QI coordinators do not project manage
Physician leaders in data sharing and literacy
"I'll show you mine, if you show me yours" - normalizes results Sessional supported
Regular data and QI "events" part of all initiatives
Learning labs and Regional QI meetings establish regular reection Facilitate data sharing, data democracy and data literacy Allow for a refocusing of action around outcomes and data
Regular "Report on Outcomes" with 20 indicators
Keeps focus on outcome indicators vs. process or output indicators Opportunity to review what we know, and explore what if any utility that provides
Evaluation and QI tools and frameworks
Toolkit of frameworks, surveys, consent forms, reports, logic models, info sharing agreements and indicators developed collaboratively
Routine data collection using standardized tools
Annual member survey, patient surveys, project check-ins Makes data collection just a part of doing business Moving towards more automated EMR data analytics
Commitment to and funding for sharing learnings
Commitment to sharing ndings, tools developed, approaches and experiences to multiple audiences
Establishing partnerships to access data, share data and collect data Communities of practice enable learning and sharing of tools
Data relationships and communities of practice
Partnerships with research organizations
Expand our reach, bring in new expertise and enable innovative projects
Provincial working groups and pilots
Ability to engage in provincial discussions Opportunity trial new tools and approaches
Embedded QI Coordinators and Evaluators Physician Leaders Protected and Sufficient Budgets Voluntary but Value Add QI not QA Outcome Focus Self- Management Regular Data and QI Events Robust Toolbox Reports on Outcomes Regular and Automated Data Collection Data Partnerships and Communities
Sharing Learnings Partnerships with research
Pilots
QI Coordinators and Coaches for each clinic Clinic QI Leads 0.8 FTE for QI Eval for 12 clinics Voluntary, but Value Add QI not QA Outcome Focus Self- Management QI and Evaluation Framework
12 outcomes and 37 indicators
Patient Experience Survey
n=1500
PCN Learning Lab CPCSSN for EMR analytics IH Data Relationship IH PCN Evaluation Community of Practice Research projects with UBC and UVic MoH Data Linking Pilot
Tools for measuring access, team & PROMS PCN Clinic Leads
Establish enabling frameworks Make data easily accessible Fund internal and external data analysts Support learning networks and communities of practice Establish key indicators collaboratively
Create a toolkit with standardized measures Enable top down and bottom up learning Incentivize data collection and reection Establish mechanisms for knowledge succession Allow for local innovation Include all stakeholders Eliminate data silos and enable data linking